Provider Information for 1396016614
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LEIGH A EVANS LMSW
Sex: Female
NPI: 1396016614
Last Updated: 2012-01-18
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1396016614 | ||||||||
| Enumeration Date | 2012-01-18 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 9536 104TH AVE LARGO, FL 33777 United States Phone: 586-909-0392 | Fax: | ||||||||
| Primary Practice Address | 9536 104TH AVE LARGO, FL 33777-1016 United States Phone: 586-909-0392 | Fax: | ||||||||
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